Clinical Services Renewal

Clinical Services Renewal (CSR) is LHSC’s proactive approach to the funding and service delivery transformation being implemented in Ontario’s health-care system by the Ministry of Health and Long-Term Care. LHSC supports the need for this system transformation in order to build a stronger and more sustainable model and, as health-care leaders with a legacy of innovation, aims to help define that future by renewing our clinical services.

Through three focused work streams encompassed by CSR, LHSC is working with all of our system stakeholders – including external partners as well as our patients and families – to drive change across the health-care continuum.

1. Clinical Strategy

The aim of the Clinical Strategy is to help identify the areas of focus where LHSC has the best opportunity to advance our position as a leader in care, innovation and education over the next three to five years.

Following a well-defined process of development and thorough system of review and evaluation, more than 400 staff and physicians informed and developed the Clinical Strategy recommendations and resulting plan. The goals of this plan are to create a nimbler and result-oriented hospital environment with stronger levels of accountability and a culture of continuous improvement.

The plan centres around a new transformational model for LHSC that is focused on changing the way we deliver clinical services as a hospital over the next five years. The first phase will focus on 11 initiatives to be implemented over two years (with ongoing continuous improvement thereafter) and the second phase will focus on aspirational strategies that will advance and enhance specific clinical services.

Of the 11 phase one initiatives, some of the most high-profile work over the past year has been on the Emergency Department (ED) System Transformation project, which aims to improve the quality of the patient and provider experience in the ED by reducing wait times and streamlining the system.

The work involved in LHSC’s Clinical Strategy will drive the transformation needed for sustained organization excellence and strengthened partnerships with our community and regional health-care providers to enhance the continuum of care, health outcomes and patient experiences.

2. Internal Improvement

The Internal Improvement work is aimed at making improvements across the five dimensions of quality: integrated, safe, timely, effective and patient- and family-centred, by finding new and innovative methods that will improve both the patient experience and quality of care provided.

The work focuses on key areas at LHSC with high intensity and/or high complexity where improvements can be tested, monitored, and evaluated. Beginning with LHSC’s perioperative care, which was divided into three main areas (pre-admission clinics, sterile processing department and supply chain, and day of surgery), each area is responsible for developing recommendations and implementation.

Using process improvement methodology, each of the above areas formed working groups which included frontline staff, physicians, leaders and patients. Each group has conducted a thorough assessment of the current state – mapping all processes, resources and workflow, and within the context of the five dimensions of quality, identified where there are opportunities to create process efficiencies, better use of resources and streamline workflow. The resulting recommendations are currently in varying stages of approval and implementation.

3. Partnering in Transformation

The purpose of the Partnering in Transformation work stream is to understand and target the highest users of the health-care system and develop improvement strategies and patient- and family-focused initiatives that will improve health-care supports available to them, reducing their degree of reliance on acute-care hospital services. This work will also help us to achieve alignment with the Ministry of Health and Long-Term Care prescribed Quality-Based Procedures (QBPs) which set the price the government will pay hospitals for certain procedures based on best clinical practices that are designed to improve quality outcomes and reduce costs. In 2014/15 the government added five new QBPs to be reviewed: hip fracture, hip and knee replacement, hyperbilirubinemia, paediatric tonsillectomy, and community-acquired pneumonia.

The work under Partnering in Transformation largely falls under three main categories:

  • Integrated care for chronic disease management (chronic obstructive pulmonary disease, congestive health failure, and diabetes);
  • Integrated care for acute complexity (QBP projects, stroke and senior-friendly hospital); and
  • Integrated care for complex populations (frail elderly, mental health and addictions)

Work in all of these areas includes developing strategies that will lower the demand on hospital services, improving management of these patient populations while they are in-hospital, as well as ensuring the appropriate level of support when they are discharged. LHSC will investigate how we can ensure this patient population receives the best care when they enter the hospital system, and will work with key partners and stakeholders in the community to determine how this patient population can best utilize these resources to support their return to the community and avoid unnecessary re-hospitalization.

Ultimately, the work undertaken in Partnering in Transformation will create greater integration of services across the health care system. It will ensure that patients will receive the right level of support, at the right time, in the right care setting – whether that be acute, ambulatory, primary, or community-based.

Strategic Priorities

Enabling Technology Plan 2.0
This plan encompasses work to improve the functionality of HUGO (Healthcare Undergoing Optimization) for end-users, and planning for the full digitization of patient records and electronic staff scheduling.


Cultural Transformation
In order to be a high-performing organization, LHSC is working to transform our culture so that patients will have a better experience, and staff and physicians will enjoy a better work environment through increased engagement, empowerment and shared accountability.


Financial and Resource Sustainability
With unprecedented investment in our infrastructure over the past decade, LHSC is working to ensure its ability to maintain our human capital and facilities, while providing safe, high-quality care in an era of declining hospital funding and growing population health needs.